Web M&M Cases & Commentaries

Fatal Patient-Controlled Analgesia Opioid-Induced Respiratory Depression

In this WebM&M spotlight case with CE/MOC a 69-year-old man with multiple comorbidities, including neck and knee pain and severe osteoarthritis, was admitted for elective decompression and to extend a prior spinal fusion. During recovery in the post-anesthesia care unit, he was placed on hydromorphone patient-controlled analgesia (PCA) for pain control and continued to receive his usual home doses of pain medication. The patient required supplemental oxygen due to peripheral oxygen saturation measurement of 88 percent. Several hours later, the patient was found unresponsive. Despite being initially responsive to resuscitation attempts, he arrested twice more; test confirmed brain death, and ventilator support was withdrawn.

The associated commentary discusses risks associated with opioid PCA use, particularly among patients at high risk for postoperative opioid-induced respiratory depression; best practices for PCA prescribing and administration; as well as for monitoring sedation and respiratory status in postoperative patients receiving opioid PCA.